Our Interdisciplinary Approach
At Roswell Park, we believe that diagnosing and treating multiple myeloma requires input from experts in different fields of oncology. Our tumor board brings together specialists from several departments to identify the best diagnostic and treatment approaches for every single patient. In cases where standard treatment options have failed, we try to find new targets of therapy to provide additional treatment options.
We work closely with the Cancer Survivorship and Supportive Care Center and Rehabilitation Therapy and Wellness Services teams to ensure that our patients enjoy the highest quality of life. A team led by Jens Hillengass, MD, investigates ways of better evaluating quality of life and learning how to improve this important part of the patient experience.
Treatment for multiple myeloma can include systemic (whole-body) options, such as proteasome inhibitors, immunomodulatory drugs, antibodies, histone deacetylase inhibitors, chemotherapy, radiation therapy, stem cell and bone marrow transplant or a combination of methods. In addition, radiation therapy, balloon kyphoplasty and vertebroplasty are used to treat painful bone disease.
The choice of treatment depends mainly on how advanced the disease is and whether or not you have symptoms. If you have multiple myeloma without symptoms, you may not need cancer treatment right away. In that case, you may have what is called smoldering myeloma, and your doctor will monitor your health closely so treatment can start if you do begin to have symptoms.
If you already have symptoms (CRAB criteria) or markers that indicate a high risk for progression (specific blood, imaging and bone marrow results) you will likely receive induction therapy, which uses combination therapy to cause remission, reducing the cancer cells in your body significantly. Often a stem cell transplant is part of the treatment plan.
Because standard treatments do not always control the cancer, eligible multiple myeloma patients should consider the option of enrolling in a clinical research study of promising new treatments that are not widely available.
The Myeloma team at Roswell Park follows the Clinical Practice Guidelines in Oncology™ developed by the National Comprehensive Cancer Network (NCCN). Jens Hillengass, MD, our Chief of Myeloma, serves on the NCCN panel of experts that develops the guidelines, which are internationally recognized standards for treating cancer patients. He also is a member of the International Myeloma Working Group, which develops guidelines for the diagnosis and treatment of myeloma and related diseases.
Selinexor (XPOVIO), a Nuclear Export Inhibitor
Roswell Park now offers selinexor (XPOVIO™), an oral therapy (pill) approved by the FDA in July 2019 for eligible multiple myeloma patients who have exhausted all other treatment options. Specifically, it is for adult patients whose disease has returned after treatment or no longer responds to therapy after at least four previous treatments.
XPOVIO is a nuclear export inhibitor. Here’s how it works: In someone who is healthy, tumor suppressor proteins scan the nucleus of each cell to look for DNA damage, which indicates the presence of cancer. If they find this damage, they alert the immune system to shut down the cancer cells.
But cancer cells have a way to prevent this. Tumor suppressor proteins must be inside the nucleus of a cell in order to work, so the cancer cells begin to produce large amounts of a protein called Exportin 1 (XPO1), which disables the tumor suppressor proteins by taking them out of the cell nucleus. XPO1 also prevents some of the cell’s other anti-cancer processes from working.
XPOVIO weakens XPO1 so that the immune system regains its power to fight the cancer naturally. XPOVIO is given along with dexamethasone, an anti-inflammatory drug that works like cortisone.